INTERACTION BETWEEN ANTIHYPERTENSIVES AND NSAIDS IN PRIMARY CARE: A CONTROLLED TRIAL

Main Article Content

Ivančica Pavličević
Marion Kuzmanić
Mirjana Rumboldt
Zvonko Rumboldt

Keywords

Antihypertensive drugs, family practice, interaction, non-steroidal anti -inflammatory drugs

Abstract

Background


Non-steroidal anti-inflammatory drugs (NSAIDs) may increase blood pressure (BP) and blunt the effects of many antihypertensives. It seems that NSAIDs and the antihypertensive drugs differ in their propensity to such an interaction.


 Objectives


To determine the extent of the interaction between two antihypertensives and three NSAIDs.


 Methods


A prospective clinical trial in a family practice included 88 treated hypertensives aged over 55 years; 39 controls and 49, also taking NSAIDs for osteoarthritis. During this 3-month study, two antihypertensives, lisinopril/hydrochlorothiazide    and   amlodipine,   were   compared    with   three   NSAID s:   ibuprofen, acetaminophen, and piroxicam. BP was measured with standard mercury sphygmomanometer and with an automatic device, in standing, sitting, and supine position.


 Results


The average starting blood pressure in the study group was 149.3±9.8/88.6±6.8 mm Hg. In the lisinopril/hydrochlorothiazide  subgroup, both ibuprofen and piroxicam elevated systolic BP by 7.7-9.9% (p<0.001), which, during the acetaminophen  period, decreased by 6.9-9.4%  to 0.3-0.9% above baseline (p<0.001), increasing again by 7.0-7.7% (p<0.001) during the second exposition to these drugs. In the amlodipine subgroup, ibuprofen or piroxicam increased BP by 1.1-1.6% (p>0.290) only, and there were no  significant   shifts  in  the  follow-up   periods.   Analogous   deviations   were   observed   with   bo th measurement  devices,  in  all  the  examinee’s  positions.  In  the  control  group,  BP  did  not  change appreciably.


 Conclusions


Piroxicam and ibuprofen markedly blunt the effects of antihypertensive  drugs while acetaminophen  is almost inert. Lisinopril/hydrochlorothiazide  combination is much more affected by this interaction than amlodipine (ClinicalTrials.gov #NCT00631514).

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